B-po05-170 catheter ablation of ventricular tachycardia in patients with cardiogenic shock in the united states: incidence, predictors, and outcomes

Ventricular tachycardia (VT) is common in patients presenting with cardiogenic shock (CS). However, the role of catheter ablation (CA) in this vulnerable population remains unclear. To evaluate the in-hospital mortality and complications of CA in CS patients with VT. The Nationwide Inpatient Sample database was queried from 10/2015 to 12/2018 for adult patients who presented with CS and developed VT (International Classification of Diseases, Tenth Edition, Clinical Modification [ICD-10-CM] code I47.2). The primary outcome was in-hospital all-cause mortality. Propensity-score matching (1:3 CA:control utilizing 18 variables) was used to evaluate in-hospital outcomes, and multivariate logistic regression was performed to identify predictors of in-hospital mortality. Of 363,570 CS patients, 65,540 (18.0%) had VT and 1,385 (2.1%) underwent CA. Ischemic cardiomyopathy was the most common co-morbidity among patients who underwent CA (45.8%). Invasive hemodynamic monitoring was utilized in 32.9% of CA group (vs 22.6% in the control; p<0.01), and 36.8% (vs 30.3% control; p<0.01) received mechanical circulatory support (MCS). In comparison with the matched control group, CA was associated with a significantly reduced all-cause mortality (25.1% vs 33.2%; p=0.01) and cardiac arrest (7.4% vs 13.4%; p<0.01). However, CA was associated with increased costs (median 333,305 vs 172,880 USD; p<0.01) and length-of-stay (median 13.0 vs 9.0 days; p<0.01). The utilization of MCS was the sole predictor of reduced mortality in those who underwent CA (odds ratio=0.38; 95% confidence interval=0.29-0.50; p<0.01). In-hospital complications included 11.4% pericardial (5.5% tamponade) and 3.3% vascular injuries in the CA group. Among patients with CS and VT, CA was associated with significantly reduced in-hospital mortality, but with increased costs and length of stay. MCS might provide favorable outcomes in patients with CS and VT undergoing CA.